On Heroin: More Users White And Suburban Than Ever Before

Four years ago, the makers of OxyContin changed the formulation so that it would be more difficult to abuse. It became less crushable and less dissolvable, so users would have more trouble snorting or injecting it. Some people predicted that this change would simply push OxyContin abusers to go for more accessible drugs – like heroin. And they were absolutely right, according to a new study in JAMA Psychiatry. Heroin is no longer a drug that inner city kids experiment with – it’s one that people, often well-to-do suburbanites, graduate to when their prescription drug addiction becomes financially unsustainable.

"In the past, heroin was a drug that introduced people to narcotics," said study author Theodore J. Cicero. "But what we're seeing now is that most people using heroin begin with prescription painkillers such as OxyContin, Percocet or Vicodin, and only switch to heroin when their prescription drug habits get too expensive."

(Photo credit: ShuttrKing|KT)

And the “type” who’s addicted to heroin has shifted considerably over the years, according to the new study. In the 1960s, the average heroin beginner was 16 years old, a minority male, and from an inner city. Now, the average age of first use is 23, and more new users are men and women from suburban or even rural areas: 90% of new users in the last decade were white. And, the study found that most heroin users – 75% – had migrated to heroin from a previous prescription opioid drug addiction.

"Our earlier studies showed that people taking prescription painkillers thought of themselves as different from those who used heroin," Cicero said. "We heard over and over again, 'At least I'm not taking heroin.' Obviously, that's changed."

The main reason for this blurring of boundaries is that buying prescription drugs on the street is becoming cost prohibitive. "The price on the street for prescription painkillers, like OxyContin, got very expensive," Cicero said. "It has sold for up to a dollar per milligram, so an 80 milligram tablet would cost $80. Meanwhile, they can get heroin for $10."

And, of course, making prescription drugs harder to crush hasn’t really helped the problem – it’s just changed where it lies. Says Cicero, “these people aren't just going to stop using drugs. As we made it more difficult to use one drug, people simply migrated to another. Policymakers weren't ready for that, and we certainly didn't anticipate a shift to heroin."

Bringing light to the problem may help to some degree: Certainly celebrities’ public or losing battles with heroin addiction have helped do that, but that’s not the only fix.

Understanding why the problem exists – what heroin use is really a symptom of – is the first step in addressing it. "You can't effectively treat people or prevent addiction unless you know why they are taking drugs, and we don't really have a handle on that yet,” says Cicero.

That’s only partly true. Stress, depression, other mental health issues are probably pretty good guesses. But it’s going to take a lot more research to understand all the causes, and more creative thinking to come up with the right treatments.